December 2020
The Human Milk Insights newsletter presents the latest breastfeeding topics and clinical practice solutions, addresses coding issues challenging the lactation community, features a lactation service, and announces upcoming webinars and conferences.
CONTRIBUTORS FEATURED STORIES THIS MONTH Katie McGee, RN, BSN, IBCLC Education Consultant NEWS YOU CAN USE Westchester, IL. ▪ Human Milk and Newborn Health Maria Lennon, MSN, CNM, IBCLC ▪ Human Milk and COVID-19 Nurse-Midwife, Perinatal Education ▪ Human Milk in the NICU Consultant ▪ Human Milk and Maternal Health Sedona, AZ. ▪ Human Milk Production
Irene M. Zoppi, RN, MSN, IBCLC ▪ Human Milk and Public Health Clinical Education Specialist Medela LLC. HUMAN MILK EDUCATION Hanover, MA. ▪ Human Milk Monthly Webinar Series ▪ COVID-19 and Breastfeeding Webinar Kim Colburn, BPC Series Education & Program Coordinator Medela LLC ▪ Breast Shield Research ▪ Neonatal Perspectives ▪ Initiation Education
CLINICAL PEARLS IN LACTATION ▪ High Energy Drinks and Breastfeeding, Are They Safe?
TOOLS YOU CAN USE Medela’s Online Breastfeeding Guide ▪
SPOTLIGHT ON PRACTICE ▪ Paula M. Sisk, PhD, RD, IBCLC
NEWS YOU CAN USE
Cibele Wolf Lebrão, MD, MSc…/September HUMAN MILK AND NEWBORN 2020 Case Study : Human milk antibodies HEALTH and protection against COVID-19 with Research Review and Meta-Analysis infected mothers https://doi.org/10.1177/0890334420960433 The Calming Effect of Maternal Breast Milk on Term Infant: A Randomized A Call to Ensure Access to Human Milk Controlled Trial for Vulnerable Infants During the COVID- Bircan Taşçı …/Published online Nov 2020 19 Epidemic Maternal breast milk odor and impact on newborn pain during heel prick blood Virginie Rigourd MD, PhD…/June sampling 2020 Impact of COVID-19 on human milk https://doi.org/10.1089/bfm.2020.0116 banking including reduction in donors and impact on recipients Research Review https://journals.sagepub.com/doi/10.1177/0 890334420938036 A Scoping Review of Research on the Research Article Human Milk Microbiome
Maureen Wimberly Groer, PhD…/July Telelactation: A Necessary Skill With 2020 Appraisal of current research Puppet Adjuncts During the COVID-19 regarding four areas of the milk microbiome Pandemic and health effects for infants Sarah Dhillon BSc Midwifery, https://doi.org/10.1177/0890334420942768 IBCLC…/September 2020 Lactation care HUMAN MILK AND COVID-19 via telehealth and useful supports during telehealth lactation consults https://doi.org/10.1177/0890334420958623 State of the Science
Implications of the COVID-19 Pandemic HUMAN MILK AND NICU Response for Breastfeeding, Maternal Caregiving Capacity and Infant Mental Systematic Review Health The Role of Human Milk in Decreasing Karleen Gribble, PhD, BrurSc*…/ FABM, FAAP…/Aug 2020 Outline review of Necrotizing Enterocolitis Through breastfeeding and infant health during the Modulation of the Infant Gut Microbiome: pandemic A Scoping Review https://doi.org/10.1177/0890334420949514 Jessica A. Davis, BSN…/August Early Identification of IgA Anti- 2020 Review summarizing gut microbiome SARSCoV-2 in Milk of Mother With and relationship of human milk and COVID-19 Infection decreased rate of necrotizing enterocolitis in
premature infants HUMAN MILK AND PUBLIC HEALTH https://doi.org/10.1177/0890334420950260 Systematic Review HUMAN MILK AND MATERNAL HEALTH Breastfeeding Protection, Promotion, and Support in Humanitarian Emergencies: A Systematic Review of Systematic Review Literature
Incidence of and Risk Factors for Immacolata Dall’Oglio, RN, MSN, IBCLC, Lactational Mastitis: A Systematic PhD…/Feb 2020 Review of optimal Review practices supporting interventions during emergencies Emily Wilson, MSc…/, April 2020 Summary https://doi.org/10.1177/0890334419900151 of risk factors for mastitis in an effort to identify prevention and continuation of ORGANIZATIONAL STATEMENTS breastfeeding AND RESOURCES REGARDING https://doi.org/10.1177/0890334420907898 COVID-19
Research Review CDC: The Centers for Disease Control and Prevention Breastfeeding Among Mothers Who Have Experienced Childhood CDC released several updated publications Maltreatment: A Review and resources:
Amara Channell Doig, MPH…/September Risk comparison of pregnant and non- 2020 Review of current research: maternal pregnant women with COVID-19 personal experience of maltreatment in https://www.cdc.gov/mmwr/volumes/69/wr/ childhood and impact on breastfeeding mm6944e3.htm?eType=EmailBlastContent outcomes and duration. &eId=5f8868d4- f92c-49d6-9c2f- https://doi.org/10.1177/0890334420950257 e86a1e43b1f3
HUMAN MILK PRODUCTION Preterm birth during pregnancy while infected with COVID-19 Research Review https://www.cdc.gov/mmwr/volumes/69/wr/ mm6944e2.htm?eType=EmailBlastContent Methods and Success Factors of &eId=5f8868d4-f92c-49d6-9c2f- Induced Lactation: A Scoping Review e86a1e43b1f3
Gemma Cazorla-Ortiz…/September 2020 Updated webpage resource list reflects new Assessment of differing approaches to evidence and considerations for pregnancy, induce lactation and factors that influence breastfeeding, and provision of human milk successful milk production related to COVID-19: https://doi.org/10.1177/0890334420950321
https://www.cdc.gov/coronavirus/2019- presenting Evolution of Hawaiian Birthing ncov/hcp/care-for-breastfeeding- and Breastfeeding Traditions and the women.html?eType=EmailBlastContent&eId Influence of COVID-19. Complimentary =61111735-e7b7-4ca5-aaeb-0f5a4079d857 registration is now open! For more information or to register, visit https://www.cdc.gov/coronavirus/2019- www.MedelaEducation.com. ncov/need-extra-precautions/pregnancy- breastfeeding.html?eType=EmailBlastConte Medela would like to invite you to look at a nt&eId=5f8868d4-f92c-49d6-9c2f- brand new dedicated webpage for e86a1e43b1f3 healthcare professionals on the global impact of COVID on Breastfeeding. It JAMA: The Journal of the American contains a lot of resources, important facts Medical Association Pediatrics and figures from research, and educational Updated resource with information and guidelines for breastfeeding while materials for professionals. COVID-19 positive, or with known www.medela.com/breastfeedingduringcovid exposure https://jamanetwork.com/journals/jamapedia Improving pumping effectiveness is critical trics/fullarticle/2772176 for many women who express their milk. Breast shield design and fit are important HUMAN MILK EDUCATION factors that can improve milk removal, comfort, and the overall pumping On Wednesday, December 2ND, Nania experience. Click here to watch the Schärer-Hernández, PhD and Leon recorded webinar by Danielle Prime, PhD Mitoulas, PhD presented Breastfeeding, The PersonalFit™ PLUS/Flex 105° Oval Human Milk and COVID-19: What Does the Breast Shield: Research Review and Evidence Say? To watch the recorded Sizing/Fitting Guidelines. webinar, please visit the following link. Please note, this recording does not offer Neonatal Perspectives This is a blog for NICU professionals that Nursing Contact Hours. features clinical information from neonatal https://www.medela.com/breastfeeding- consultants, as well as industry news and professionals/news-events/2020-webinar- popular topics. Click here to read the latest series blogs.
On Thursday, December 10th, Dani Interested in learning more about initiation Dumitriu, MD, PhD and Cynthia Gyamfi- of breast milk? Click here to see what Bannerman, MD, MSc, FACOG will be education tools we have available. We also presenting Protecting the Mother-Baby have promo codes for the following online Dyad During the COVID-19 Pandemic: The courses.
Columbia University Experience. Initiation of Lactation: At Risk Mothers and Complimentary registration is now open! For Proactive Interventions Promo code more information or to register, visit XS6TSP www.MedelaEducation.com. Initiate, Build and Maintain Milk Supply On Wednesday, December 16th, Amanda Promo code GQ6NET Gontarek, BSN, RN, IBCLC will be
CLINICAL PEARLS IN LACTATION
This column is for lactation practitioners to share clinical challenges and successes, observations and pearls with colleagues. To share a clinical pearl, submit it here. If your submission is selected for publication in a future issue of Human Milk Insights, you will receive a $25.00 VISA gift card.
High Energy Drinks and Breastfeeding, Are They Safe?
It’s getting close to the holidays, which means it’s time for even more shopping, cooking, cleaning - all while helping the little ones with their online lessons, caring for a newborn, and perhaps even working from home too. How is a mother to manage? No wonder some mothers are reaching for popular energy drinks to get an energy boost and relieve fatigue.
But are energy drinks safe to consume while breastfeeding?
As a general rule, consuming caffeine in moderation is considered safe for breastfeeding mothers. That means about 3 cups of coffee per day (300 - 500 mg) or a couple of energy drinks, depending on the brand.
It’s important for mothers to observe their babies for signs of caffeine stimulation because some infants who are very sensitive to the effects of caffeine may exhibit a rapid heart rate, fussiness, and sleeplessness. Caffeine is a unique drug in that it has a long half-life in infants. The half-life of caffeine in a newborn is approximately 100 -120 hours. At 3-5 months of age, the half-life is decreased to 14 hours. As infants get older, they can metabolize caffeine more efficiently, and may be able to tolerate caffeine if their mothers are consuming it in beverages or foods versus showing stronger sensitivity signs to this drug as newborns.
Mothers who are breastfeeding babies who are ill, have gastroesophageal reflux, diagnosed heart arrhythmias, or prolonged QT interval should use extreme caution when using caffeine, as these symptoms can be exacerbated. It’s also important for mothers who drink coffee, tea, or energy drinks to be aware of other products that also contain caffeine: chocolate, sports drinks, over-the counter medications, soft drinks, some herbal products, and other items. Encourage mothers to read labels, know what they are putting into their bodies, and understand how it can affect them and, in turn, their babies.
So, like most things in life, when it comes to energy drinks and breastfeeding, moderation is key.
References: https://www.caffeineinformer.com/the-caffeine-database http://infantrisk.com/content/high-energy-drinks-and-breastfeeding http://www.energyfiend.com/the-caffeine-database
TOOLS YOU CAN USE
Medela’s Online Breastfeeding Guide
Are you looking for a handy ready-to-use online resource to introduce to the mothers you work with? You need look no further than the Medela website: https://www.medela.us/breastfeeding/articles
Mothers are still the same as they’ve always been, which means often needing a lot of information and support during pregnancy, birth and afterwards. During the time of COVID-19, mothers are not able to access all the breastfeeding assistance resources that were so plentiful before. In many locations, group in-person prenatal breastfeeding classes are no longer being held, face-to-face visits with other moms with new babies are not happening and, even visits from experienced friends and family members have stopped. The need for education and support is still here - even more acute in COVID times, with new mothers being isolated and alone.
The online Breastfeeding Guide is a collection of short articles – on 242 subjects related to breastfeeding and motherhood. There is a search function at the top of the page where mothers can type in a topic, or they can scroll down the page to read the titles associated with fun and attractive pictures.
Sample topics include:
• What Breast Milk is Made of: Liquid Gold Science • How to Prepare for Breastfeeding While Expecting • How Does Breastfeeding Work? • Mastering the Breastfeeding Latch for Success • Breastfeeding a Premature Baby: Best Practices • Breastfeeding Resources: Tools (from Medela) You Can Use • 6 Common Breastfeeding Myths, Busted • How to Manage Cluster Feeding and Fussy Evenings • 6 Tips for Increasing Your Breast Milk Supply • The Best Breast Pump Options for Every Mom • Breast Shield Sizing and How to Get the Best Fit • How Does Maternity Leave Work? Understanding Your Rights and Protections • Important Breast Milk Storage Guidelines and Tips • Introducing Solids and Baby-Led Weaning
Medela’s website contains numerous “mom-sized” bites of information that mothers will find useful throughout their breastfeeding journeys. Every mother’s situation is unique; she can pick and choose the topics in the Breastfeeding Guide that she’s most interested in and feels will be most helpful in her situation.
Check out the Medela website: https://www.medela.us/breastfeeding/articles and see what kind of support is available to the mothers you care for.
SPOTLIGHT ON PRACTICE
This column is for lactation practitioners and facilities who wish to acknowledge the work of others. We invite you to submit suggested practitioners or facilities you would like to spotlight. If you have a suggestion, email [email protected].
This month we are spotlighting Paula M. Sisk, PhD, RD, IBCLC, Winston-Salem, NC
Paula M. Sisk has spent her professional career as a gifted Registered Dietitian (RD) working to improve the nutritional health of vulnerable infants. An ardent researcher and voracious author of numerous peer reviewed journal articles, Paula currently works as a Registered Dietitian and Lactation Consultant in the NICU at Novant Health Forsyth Medical Center.
Born and raised in a little North Carolina mountain town, Paula knew her family’s expectation to attend college would take her away from the small town of Spruce Pine. Her interest in studying nutrition and the program of studies offered at nearby universities drew Paula to attend Western Carolina University in Cullowhee, NC, another small town. After graduation, Paula secured a one year clinical dietetic internship at Emory University and afterward moved to Black Mountain, where she worked as Clinical Dietitian at a residential facility. After a few years and realizing her desire to provide nutrition guidance within an acute care facility, Paula began working with patients in a cardiac rehabilitation program. After she was asked to cover for a pediatric RD on maternity leave, Paula became involved in providing nutrition assessments for infants in the NICU.
After relocating with her family to Winston-Salem, Paula secured a position as a RD in an acute care facility. Within a couple of years she began working in the neonatal intensive care unit. Having breastfed her own children, Paula became acutely aware of what she didn’t know about breastfeeding . Supported by the guidance of the Medical Director of the NICU, Paula sought to learn as much as she could about supporting mothers on their breastfeeding journeys. The support and guidance she received propelled her to achieve the IBCLC certification and earn her PhD.
Paula has witnessed significant challenges NICU families are experiencing in light of the coronavirus pandemic. She acknowledges families face increased stressors, such as caring for school age children in hybrid learning situations and transportation issues getting to the hospital. When the pandemic first occurred, parental visiting in the NICU was restricted to one parent but that has evolved to allowing both parents to visit simultaneously. In spite of 24/7 lactation consultant coverage on the mother/baby units and 7 day/week lactation consultant coverage in the NICU, mothers still struggle to maintain a pumping schedule. Increased responsibilities caring for family members, community lock-downs, lack of extended family contact, and social isolation – all of which make keeping a pumping schedule challenging for even the most disciplined mothers.
Paula acknowledges her professional success would not have occurred without the support of her loving husband, Mark. Married for 38 years, they have three adult children, one grandson and a 2 year old chocolate Labrador retriever. The family enjoys spending time together and relaxing in the family backyard pool. Paula and Mark recently purchased a camper and found it convenient to travel on weekends this summer accompanied by their dog.
Paula also acknowledges and greatly appreciates the wisdom and guidance of specific individuals who influenced her career. The late Mary Rose Tully was the first person Paula heard speak on the topic of
breastfeeding and was immediately enthralled. After listening to Ms. Tully’s remarkable presentation, Paula began to explore a career path assisting breastfeeding families.
Currently a retired professor from the University of North Carolina at Greensboro, Dr. Cheryl Lovelady was Paula’s graduate advisor while she was earning her PhD. Paula credits Dr. Lovelady’s guidance on researching lactation and nutrient needs as an impetus for her own subsequent research.
Paula credits Dr. Robert Dillard for being her mentor and for the course her career has taken. The father of 6 breastfed children, he encouraged and supported Paula’s initial work assisting NICU breastfeeding families and the pursuit of her PhD. He recruited Paula to work alongside him at Novant Health Forsyth Medical Center when he became the NICU’s Neonatal-Perinatal Medical Director. Together, they have conducted and published several research studies.
Paula admits, ‘I have been very fortunate to have these remarkable people enter my life at key times in my career. I suppose it was destiny.’
As a registered dietician and lactation consultant, Paula has committed herself to supporting the nutritional needs of vulnerable infants. She has directed many research projects on the provision of human milk for vulnerable infants with particular emphasis on education and support for mothers. Paula is a prolific author of publications that are well recognized within lactation and NICU settings. She is the recipient of many notable honors and awards, including the Outstanding Dissertation Award for her PhD from the University of North Carolina (Greensboro), the North Carolina Dietetic Association Graduate Scholarship, the David Stedman Graduate Scholarship, the Ramsey Johnston Ferguson Scholarship, and a travel grant to attend the 2002 International Society for Research in Human Milk and Lactation (ISRHML) meeting in Mexico City, Mexico. Paula is also an Adjunct Professor in the Department of Pediatrics at Wake Forest School of Medicine. Paula’s enthusiasm for educating families and clinicians about the value of human milk for NICU infants is boundless. Multitudes of families are grateful for her wisdom, her quest for conducting research, her compassion and her energy. The Lactation Community is grateful for her work.